The Effects of Biologic Agents on Carotid Intima‐Media Thickness and Hepatic Steatosis in Patients With Moderate‐To‐Severe Psoriasis: A Prospective Observational Cohort Study

Background Psoriasis is a chronic immune‐mediated systemic inflammatory disease associated with multiple comorbidities. Systemic inflammation in psoriasis is thought to contribute to the development of atherosclerosis‐related cardiovascular diseases and non‐alcoholic fatty liver disease (NAFLD). Biological therapies may exert beneficial effects on these comorbidities by suppressing inflammatory pathways. Objectives To comparatively evaluate the effects of anti–TNF‐α, anti–IL‐12/23, and anti–IL‐17 biologic agents on carotid intima–media thickness (CIMT), a marker of subclinical atherosclerosis, and hepatic steatosis after 6 months of treatment in patients with moderate‐to‐severe psoriasis. Methods This single‐centre, prospective, observational cohort study included 34 patients with moderate‐to‐severe psoriasis. Patients were grouped according to the biologic agent used: anti–IL‐12/23 (ustekinumab, n = 7), anti–TNF‐α (adalimumab, certolizumab pegol, n = 9), and anti–IL‐17 (secukinumab, ixekizumab, n = 18). CIMT and hepatic steatosis grades were assessed by ultrasonography at baseline and after 6 months. Changes in laboratory parameters, including C‐reactive protein, liver function tests, and lipid profile, were also evaluated. Results In the overall cohort, significant reductions in CIMT and hepatic steatosis grades were observed at 6 months ( p < 0.01). No significant changes were detected in the anti–TNF‐α group ( p > 0.05). A significant reduction in CIMT was observed in the anti–IL‐12/23 group ( p < 0.05), without a significant change in hepatic steatosis. In the anti–IL‐17 group, both CIMT and hepatic steatosis grades decreased significantly ( p < 0.05). Intergroup comparisons revealed no significant differences in CIMT changes ( p > 0.05), whereas changes in hepatic steatosis differed significantly between groups ( p < 0.05). No significant changes were observed in laboratory parameters. Conclusions Biologic therapies used in psoriasis may have beneficial effects on subclinical atherosclerosis and hepatic steatosis by reducing systemic inflammation. Among the treatment groups, anti–IL‐17 agents demonstrated the most pronounced improvement in hepatic steatosis, suggesting a potential added benefit in patients with metabolic comorbidities.